Managing Benign Prostatic Hyperplasia in Elderly Men

Introduction

Benign prostatic hyperplasia (BPH) is when the prostate and its surrounding tissues increase in size. Prostate in males undergoes two growth phases as they age; one during puberty and the other after age 25. During puberty, the prostate becomes almost double in size, and after age 25, it continues to grow throughout a man’s life. Normally, the prostate keeps growing with age, but when it grows too much and causes problems, it is known as benign prostatic hyperplasia.

Abnormal growth of the prostate presses against the urethra, causing the bladder walls to thicken and become weak, thus losing the ability to empty fully. This causes the urine to remain in the bladder, leading to the lower urinary tract symptoms of benign prostatic hyperplasia. Though the condition is not cancerous, the symptoms can be severe, indicating a serious medical condition, such as prostatic cancer.

What Are the Causes of Benign Prostatic Hyperplasia in Elderly Men?

The actual cause of benign prostatic hyperplasia is not clear, and it is thought to be caused by some hormonal changes in the testis. The condition is common in older men. During this phase of life, the testosterone levels in the blood decline while the estrogen levels remain the same. These hormonal changes trigger the growth of the prostate, and benign prostatic hyperplasia occurs.

Some studies about this condition also suggest that high levels of dihydrotestosterone (DHT) in older men can be the reason, as it is responsible for prostate development. It also causes a drop in testosterone levels in the body.

What Are the Symptoms of Benign Prostatic Hyperplasia in Elderly Men?

The symptoms of benign prostatic hyperplasia are as follows:

• Frequent urination, about every one to two hours.

• Dribbling or slowing while peeing.

• Inability to empty the bladder fully.

• Difficulty while peeing.

• Incontinence or leaking.

• Smelly pee.

• Painful peeing and ejaculation.

• Nocturia or waking up at night more than twice to pee.

• Change in the color of urine.

How Is Benign Prostatic Hyperplasia Diagnosed in Elderly Men?

The diagnostic tests for benign prostatic hyperplasia include:

• Symptom Score Index: This score rates benign prostatic hyperplasia as mild to severe based on the urinary changes and symptoms experienced by the patient. A symptoms score test is often the first step towards diagnosing benign prostatic hyperplasia.

• Physical Examination: The next step is a digital rectal exam or DRE. During this, a person is made to lie on the side or bend over. The doctor inserts a lubricated, gloved finger into the rectum of a person, up to the back of the wall, to check the prostate gland. The examination checks for lumps, tenderness, enlargement, and hard spots. This is a 10 to 15-minute examination.

• Blood Tests: In cases where cancer is suspected, a blood test, known as PSA or prostate-specific antigen test, is advised by the doctor. This test checks PSA proteins made only by the prostate gland. The test is either performed in the clinic or hospital. A person is advised to avoid sexual activity for several days before going for this test, as sexual intimacy causes artificial increases in PSA levels.

• Diagnostic Scans: These scans are used to measure the shape and size of the prostate gland. Scans include:

  • Cystoscopy: To examine the bladder and urethra.

  • Ultrasound: To view the inside of the body and evaluate the size and shape of the body.

  • Computed Tomography and Magnetic Resonance Imaging: These are detailed diagnostic scans for surgeries if urine flow is reopened. The scan provides a detailed view of the prostate and its surrounding areas and also shows the exact location and area of prostate enlargement.

How Is Benign Prostatic Hyperplasia in Elderly Men Managed?

• Active Surveillance: Benign prostatic hyperplasia is usually watched actively without any treatment by the urologist. It is mostly examined over a year, and a doctor may suggest exercise and diet to manage the symptoms caused by benign prostatic hyperplasia.

• Medication: The commonly prescribed medications for relaxing the muscles of benign prostatic hyperplasia include Terazosin, Alfuzosin, Tamsulosin, Silodosin, and Doxazosin. Additionally, certain medications are prescribed to slow down the growth of the prostate, such as Dutasteride and Finasteride.

• Surgeries:

  • Green Light Laser: This test involves a special laser to evaporate the oversized prostate.

  • Transurethral Electrovaporization: In this procedure, an electrode is used to heat the prostate tissues to turn them into steam.

  • Transurethral Invasion of the Prostate (TUIP): This procedure improves urine flow by widening the urethra by making two minor incisions in the prostate, where the bladder and urethra join.

  • Transurethral Resection of the Prostate (TURP): In this procedure, a resectoscope, a special type of instrument, is used to remove prostate tissues via the urethra.

• Minimal Invasive Treatments: Modern surgeries for benign prostatic hyperplasia are less invasive. However, there is not much information available about these minimally invasive techniques. Therefore, their long-term effects and complications are still not known.

  • Water Vapor Therapy: In this technique, an instrument is inserted and moved up to the prostate. A needle is then ejected, which emits steam vapors that turn into water. The thermal energy of this water destroys the prostate, causes its cells to reabsorb, and causes the prostate to shrink.

  • Prostatic Urethral Lift: This technique helps to make pee easy by enlarging the lobes of the prostate. An instrument called UroLift is inserted into the prostate via the urethra, which ejects small implants and pulls out the lobes of the prostate to open the urethra. The number of implants is placed according to the size of the prostate.

How to Prevent Benign Prostate Hyperplasia?

Benign prostate hyperplasia can be prevented by making lifestyle changes, such as exercising for at least 30 minutes daily to slow down the growth of the prostate. Also, maintaining normal blood glucose and cholesterol levels is important for managing BPH.

Conclusion

To conclude, the prognosis of benign prostate hyperplasia is quite good; however, the condition does not have any cure. The treatment is mainly available to alleviate the symptoms of BPH. Additionally, BPH does not require any treatment if the symptoms are mild. In cases where a person is experiencing severe symptoms, medication, surgeries, and other minimally invasive procedures are advised by the doctor.